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Solid pseudopapillary neoplasm (SPN) of the pancreas is a rare pancreatic tumor with low malignant potential. It occurs characteristically more often in young women. Radiological and pathological studies have revealed that the tumor is quite different from other pancreatic tumors. Limited information is available in the literature reporting their accumulation of fluorine-18 fluorodeoxyglucose (18F-FDG) in positron emission tomography/computed tomography (PET/CT). Here, we report a case of pancreatic SPN imaged with contrast-enhanced FDG PET/CT. A percutaneous fine needle aspiration from the metabolically active lesion revealed SPN, and it was confirmed with histopathological results. Recurrence or metastasis was not found after 7 months of follow-up.

Introduction: Imaging has a well-established role in the evaluation of recurrent ovarian cancer.18F-FDG PET/CT is an effective whole-body imaging technique that detects metabolic changes preceding structural findings. The aim of this retrospective study was to determine whether18F-FDG PET/CT can replace contrast enhanced computed tomography (CECT) as an initial imaging modality for recurrence detection in ovarian carcinoma patients with raised CA-125 levels. Material and Methods: The present study was carried among 52 women with suspected recurrence i.e. raised CA-125 levels and/or CECT scan findings, referred for18F-FDG PET/CT were studied. 44 patients underwent both18F-FDG PET/CT & CECT studies (Group A-I, A-II and B) and 8 patients underwent18F-FDG PET/CT only (Group C). Data analysis was done using Wilcoxon Match Pairs Signed Rank test. Results: In 44 patients where both18F-FDG PET/CT & CECT were done,18F-FDG PET/CT & CECT detected lesions in 42/44 (95.5%) and 26/44 (59%) patients respectively. Comparison of 42 positive18F-FDG PET/CT studies with CECT showed that18F-FDG PET/CT modified disease distribution in 34 patients i.e. more extensive disease in 18 (Group A-II) and detected disease in 16 CECT negative patients (Group B), (p <0.001). Recurrence was detected in all 8 patients who underwent18F-FDG PET/CT only (Group C). No statistical significant difference was found between the mean (p 0.378) & median (p 0.760) values of CA-125 in all the 4 groups. Conclusion:18F-FDG PET/CT should be preferred initial imaging modality in suspected recurrent ovarian cases as it depicts larger disease burden when compared to CECT and can modify the treatment plan in cases with solitary lesions on CECT.

Purpose: To evaluate if any linear relationship exists between CA-125 levels and degree of disease burden in suspected recurrent ovarian carcinoma cases on PET/CT and to establish a possible CA-125 cut-off value which could predict whether the active disease predominantly involves lymph nodal stations or intra-abdominal soft tissue sites. Methods: This retrospective study involved 42 patients (35-74 years) with suspected disease recurrence based on raised CA125 levels referred for PET/CT scan. Patients were classified into three groups based on the range of CA-125 levels. Number of lesions per patient was counted. Data analysis was done using appropriate statistical tests. Results: PET/CT detected a total of 57 lesions in Group A (n=18), 68 in Group B (n=14) and 65 lesions in Group C (n=10) respectively. No significant statistical difference was found in the total number of lesions detected in all the three groups. No significant statistical difference was seen when comparing total number of lesions detected on PET/CT in groups with marked difference in CA-125 levels. When the number of lesions detected on PET/CT in each patient was correlated, no correlation (r = 0.342) between the CA-125 levels and disease burden was observed. A cut-off CA-125 value of 350 U/ml was established to be significant (p-value <0.001) in suggesting whether the active disease predominantly involves lymph node or intra-abdominal soft tissue sites. Conclusion: There exists no relationship between CA-125 levels and degree of disease burden detected on PET/CT suggesting that higher degree of disease burden may be found in low levels of raised CA-125 levels and vice versa. A cut-off of 350 U/ml of CA-125 may be useful to predict the predominant disease distribution pattern i.e. lymph nodal stations versus soft tissue deposits in these patients.